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UNDERSTANDING VULVODYNIA: DIAGNOSTIC CHALLENGES AND MULTIMODAL INTERVENTIONS
Get PDFBackground: Vulvodynia is defined as vulvar pain lasting at least three months and remains a challenging condition of unknown etiology. Despite its high prevalence and significant impact on quality of life in women, data on its prevalence in the Polish population is lacking. Due to its complexity, vulvodynia is often underdiagnosed.
Aim: This study aims to review the current literature on vulvodynia. A systematic review of relevant publications was conducted to summarize existing evidence and clinical approaches for this condition.
Material and Methods: Relevant articles on vulvodynia were searched
Results: The reviewed studies indicate that the etiological factors of vulvodynia remain unconfirmed, with potential factors that may either initiate or aggravate the condition. This complexity complicates diagnostic pathways due to the lack of a clear clinical reference point. Due to the multifactorial nature of vulvodynia, clinicians may need to prescribe multiple therapies, such as oral therapy, physiotherapy, surgical procedures, targeting different pain mechanisms to achieve effective symptom management.
Conclusions: Further research is essential to explore effective treatment strategies and to better understand the challenges faced by women facing vulvodynia
COMPREHENSIVE REVIEW OF TREATMENT OPTIONS FOR ERECTILE DYSFUNCTION: MODERN AND TRADITIONAL METHODS
Get PDFIntroduction: Erectile dysfunction (ED), or impotence, is a condition where a man can't get or keep an erection firm enough for satisfying sexual intercourse. It affects men of all ages and is caused by a variety of physical, psychological, or social factors. The number of ED cases is growing annually, and treatment costs are rising steadily. This combination of increasing prevalence and rising expenses highlights the need for a highly optimized treatment method. Efforts should focus on finding a solution that is as effective as possible while also being cost-efficient. The goal is to provide accessible, high-quality care without the financial burden, ensuring that men who suffer from this condition can find relief and improve their quality of life. The search for such a method is crucial given the growing impact of ED on men worldwide.
Aim: The aim of this study was to review literature studies on ED and methods for treating this condition.
Method: Data for the article were retrieved by using Pub Med setting the time descriptor to 2020-2025.
Conclusions: Despite the availability of many effective treatments for erectile dysfunction (ED), it can still be a challenging condition due to the variety of underlying causes. Therefore, an individualized approach and thorough diagnostics are essential. Regenerative therapies and shockwave therapy, although still experimental, offer new therapeutic opportunities. In the future, it will be important to conduct randomized studies with long-term follow-up to assess the effectiveness and safety of these new methods
ABNORMALLY INVASIVE PLACENTA: A LITERATURE REVIEW ON RISK FACTORS, DIAGNOSTIC CHALLENGES, PATHOPHYSIOLOGY, AND CLINICAL MANAGEMENT
Get PDFPlacenta accreta spectrum (PAS) is a term used to describe a pathological condition characterised by abnormal placental adherence or invasion of the myometrium or extrauterine structures (1). The condition is characterised by adhesion to the myometrium in the presence of placenta accreta, invasion of the myometrium by placenta increta, and extension of the placenta through the serosa into adjacent organs, a condition known as placenta percreta(1–4) Placenta accreta spectrum disorders (PASDs) are a group of conditions characterised by the excessive adherence of the placenta, which results in the failure of the placenta to separate during birth.
It is widely acknowledged that PASD represents one of the most dangerous conditions associated with pregnancy. In a considerable number of cases, the condition remains undiagnosed prior to delivery. Achieving correct prenatal diagnosis is imperative in order to reduce the burden of maternal and fetal morbidity. Despite the fact that ultrasound remains the imaging modality of choice, magnetic resonance imaging (MRI) is necessary for the evaluation of areas which are difficult to visualise using ultrasound, as well as for the assessment of the extent of placenta accreta (1,2,5,6).
The implementation of effective management strategies is paramount in achieving optimal outcomes. A multidisciplinary approach is required, in addition to the establishment of adequate infrastructure (1). This article defines the characteristics, risk factors, diagnosis, management and outcomes of placenta accreta spectrum, highlighting a multidisciplinary approach
THE GUT MICROBIOME AND ITS ROLE IN HUMAN HEALTH
Get PDFIntroduction: The human gut microbiome has become the subject of intensive scientific research in recent years due to its significant impact on the body. Disturbances in its composition, called dysbiosis are linked to diseases such as inflammatory bowel disease (IBD), obesity, type 2 diabetes, allergies and neuropsychiatric disorders. This review summarizes current knowledge about the gut microbiome - its composition, functions, research methods, therapeutic options and health impact.
Materials and methods: The review was based on an analysis of scientific literature from the PubMed database. The selected publications concerned the composition and development of the microbiome, its function in the pathogenesis of diseases and diagnostic methods and therapeutic strategies.
Results: The gut microbiome is a complex ecosystem of bacteria, viruses, fungi and archaea. It develops from the perinatal period depending on delivery mode, feeding, diet, antibiotics, and lifestyle. It ferments undigested components into short-chain fatty acids (SCFA), synthesizes vitamins, modulates immunity and protects against pathogens. Dysbiosis is linked to chronic inflammation "leaky gut" and metabolic, autoimmune and neuropsychiatric diseases. Therapies include probiotics, prebiotics, synbiotics, diet changes, fecal microbiota transplantation (FMT) and new methods such as bacteriophages or precise microbiome editing using CRISPR-Cas technology (a biological system that bacteria and archaea use to defend against viruses).
Conclusions: Growing evidence supports the critical role of the gut microbiome in health. Although the links between dysbiosis and disease are clear, direct causality remains uncertain. Future research should identify key microorganisms, develop personalized therapies based on microbiota modulation and ensure the safety of treatments. Properly shaping the microbiome may open new possibilities for preventing and treating chronic diseases
HEART RATE VARIABILITY IN ATHLETES: INDICATOR OF TRAINING LOAD, RECOVERY AND CARDIOVASCULAR HEALTH
Get PDFIntroduction: Heart rate variability (HRV) is a non-invasive biomarker reflecting autonomic nervous system activity. In recent years, its use in sports medicine has increased significantly due to its usefulness in monitoring training load, recovery, and cardiovascular health in athletes.
Material and methods: This review summarizes the current state of knowledge on the physiological basis of HRV, measurement methods, and practical applications in athlete populations. This study is a literature review based on data from PubMed and Google Scholar.
Results: HRV parameters, particularly RMSSD (the square root of the mean of the squares of differences between successive RR intervals) and SDNN (the standard deviation of NN intervals), show a clear sensitivity to training intensity and recovery status. Studies show that HRV-guided training can improve performance measures such as VO₂max (maximal oxygen consumption) and reduce the risk of overtraining. HRV also responds to changes related to sleep quality, supplementation, and biofeedback interventions. Despite technological advances, there are still challenges related to standardizing measurement protocols and accuracy across devices. Low HRV is also associated with increased cardiovascular risk, which additionally creates a potential role in early detection of arrhythmia or autonomic imbalance in athletes.
Conclusions: HRV is a valuable tool in personalized training management and monitoring cardiovascular health. The use of similar measurement protocols and interpretation of trends rather than single values increases its utility in both competitive and recreational sports. Future research should seek to integrate HRV with other physiological measures and validate wearable technologies in diverse athlete populations
MEASURING MEDICATION ADHERENCE THROUGH MOBILE APPS: A SOCIAL SCIENCE PERSPECTIVE
Get PDFMedication adherence is a critical factor influencing the effectiveness of chronic disease management and overall public health outcomes. Despite advances in pharmacotherapy and the availability of effective medications, adherence rates among patients with chronic illnesses remain suboptimal, often as low as 50%, and even lower for asymptomatic conditions such as hypertension. Poor adherence not only reduces the potential benefits of therapy but also contributes to disease progression, increased morbidity, frequent hospitalizations, and substantial financial burdens on healthcare systems. This review provides a comprehensive overview of current methods for measuring medication adherence, including traditional approaches such as self-report, pill count, and clinician assessment, as well as advanced technological solutions like electronic medication packaging (EMP) devices, mobile health (mHealth) applications, video observed therapy (VOT), and ingestible biosensors.
The discussion highlights the strengths and limitations of each method, emphasizing that no single approach is flawless and that a multidimensional strategy often yields the most reliable results. Patient-related factors such as knowledge, beliefs, psychological state, and the quality of the patient-provider relationship are identified as key influences on adherence behavior. Socioeconomic variables, cognitive impairment, and regimen complexity further complicate adherence, especially in older adults and vulnerable populations. Recent advances in digital health offer promising avenues for real-time monitoring and tailored interventions, but challenges remain regarding accessibility, cost, user engagement, and data privacy.
The review concludes that improving medication adherence may have a more profound impact on public health than developing new therapies. Effective solutions require a holistic approach that integrates reliable measurement, patient-centered care, technological innovation, and system-level support. Ongoing research, collaboration across disciplines, and policy efforts are crucial to bridging the gap between prescribed treatments and real-world patient behavior, ultimately improving health outcomes and reducing healthcare expenditures
SYSTEMATIC REVIEW OF PHARMACOTHERAPY STRATEGIES IN THE MANAGEMENT OF HIDRADENITIS SUPPURATIVA
Get PDFIntroduction: Hidradenitis suppurativa (HS, acne inversa) is a chronic, recurrent inflammatory dermatosis with an etiopathogenesis that remains not fully understood. Characteristic skin lesions—nodules, abscesses, sinus tracts, and scars—are most commonly located in skin fold areas, leading to a significant deterioration in patients’ quality of life, both physically and psychosocially. Despite advances in medical knowledge, the diagnosis of HS is often delayed, and treatment represents a major clinical challenge requiring individualized therapeutic approaches. This article provides a review of current literature on pharmacological treatment strategies for HS, including both topical and systemic therapies. Particular emphasis is placed on antibiotic therapy (e.g., tetracyclines, combination therapy with clindamycin and rifampicin, triple-drug regimens, ertapenem), as well as hormonal and immunomodulatory treatments. Furthermore, the growing role of biologic therapies, including TNF-α and interleukin inhibitors, and the use of emerging targeted agents under investigation are discussed. Attention is also drawn to the importance of androgen receptors and their potential role in the pathogenesis of HS, as reflected in the effectiveness of antiandrogen therapies (e.g., spironolactone or oral contraceptives containing a progestogenic component). The review includes data on the efficacy, safety, and limitations of various therapeutic methods based on clinical trials and systematic reviews. The need for further research on the skin microbiome and immune response mechanisms is highlighted, as it may serve as a basis for the development of new, more targeted therapeutic interventions. It is emphasized that HS treatment should be multidimensional and tailored to disease severity as well as coexisting metabolic and endocrine disorders.
Materials and Methods: The article was written based on scientific papers available on PubMed and Google Scholar
Key findings: Analysis of current evidence indicates that pharmacotherapy constitutes a fundamental component in the management of hidradenitis suppurativa (HS), with treatment outcomes strongly dependent on disease severity. Biological therapies, including adalimumab, secukinumab, and belimumab, have demonstrated significant clinical efficacy in moderate to severe HS, particularly in individuals unresponsive to conventional therapies, and represent a major advancement in disease management. Antibiotics remain widely used, providing symptomatic relief despite HS being a chronic inflammatory rather than an infectious condition. Topical clindamycin (1%) is effective in mild cases with superficial inflammatory lesions but shows limited efficacy in deep nodules and carries a risk of microbial resistance. Systemic antibiotic therapy, especially clindamycin combined with rifampicin, has achieved clinical remission in a substantial proportion of moderate HS cases, whereas severe disease may require intensified regimens, including metronidazole, rifampicin, moxifloxacin, or intravenous ertapenem; however, relapse rates following treatment discontinuation remain high. Anti-androgen therapies, such as spironolactone, finasteride, cyproterone acetate (CPA), and metformin, have demonstrated beneficial effects in women with hormonally driven flares or hyperandrogenic comorbidities. Novel topical and systemic anti-androgen agents (finasteride, flutamide, clascoterone, leuprolide) are currently under investigation, but high-quality randomized controlled trials are
Conclusions: Hidradenitis suppurativa remains a significant therapeutic challenge, with current pharmacological strategies providing only partial and often temporary disease control. Biologic agents offer substantial clinical improvement in refractory moderate to severe HS, whereas antibiotics and anti-androgen therapies remain valuable options in mild to moderate disease, albeit with limitations such as high relapse rates and potential adverse effects, including antimicrobial resistance. The complex and incompletely understood pathophysiology of HS highlights the urgent need for further research into immunologic, microbial, and hormonal pathways to facilitate the development of targeted and personalized treatment approaches
FROM EXPOSURE TO ONCOGENESIS: THE ROLE OF MICROPLASTICS AND ASSOCIATED POLLUTANTS IN CANCER - A LITERATURE REVIEW
Get PDFIntroduction and purpose: Microplastics (MPs) are defined as particles smaller than 5 mm. They are ubiquitous environmental pollutants. They enter the human body primarily through food, water and inhaled air. This paper focuses on a collection of scientific studies concerning the accumulation of MPs in human tissues and their impact on cancer development, also considering the role of MPs as carriers of known carcinogens.
Brief description of the state of knowledge: In recent years, MPs have attracted considerable scientific attention. Their effects on human health, including oncology, have begun to be investigated. This area remains poorly studied, although new publications are emerging rapidly. Systematic reviews specifically addressing the oncological consequences of MPs are also lacking. Therefore, we see the need to summarize the current state of knowledge in this aspect.
Summary (conclusions): Increased levels of polyethylene (PE), polypropylene (PP), polystyrene (PS) and polyvinyl chloride (PVC) have been detected in tumor tissues such as breast, colorectal, pancreatic, prostate, lung and cervical cancers. In vitro and in vivo studies show that MPs stimulate tumorigenesis by enhancing cell proliferation, epithelial-mesenchymal transition, migration and activation on oncogenic PI3K/AKT and MAPK/ERK pathways. Moreover, MPs can serve as vectors for carcinogens (for example, polycyclic aromatic hydrocarbons and bisphenols). We hope this review will help guide future research directions
SEMAGLUTIDE AND BODY COMPOSITION: A NARRATIVE REVIEW OF ITS EFFECTS ON LEAN MASS AND STRATEGIES FOR PRESERVATION
Get PDFIn recent years a steady increase in the prevalence of obesity has caused a growing interest in pharmacological anti-obesity treatment, including semaglutide, glucagon-like peptide-1 (GLP-1) receptor agonist, which has been proven effective in inducing weight loss in obese patients. However, due to rapid growth of its popularity, monitoring and updatig of guidelines and potential adverse effects may have been outpaced. One of the adverse effects taken into consideration is semaglutide’s impact on reduction of lean mass, fat-free mass and muscle mass. Available studies, although not unanimous, indicate that although decrease of lean mass occurs alongside loss of fat mass, proportion of lean mass increases. Moreover, some studies suggest that semaglutide treatment has a positive impact on muscle function. Nevertheless, the search for strategies allowing for mitigation of lean mass loss during this treatment is still necessary, particularly considering groups of patients at risk of such a complication. Two approaches are being considered: lifestyle interventions and pharmacological treatment. Studies suggest that resistance exercise training interventions can elicit significant increases in lean mass during semaglutide treatment. When it comes to dietary interventions, there is significant need for research that would aim at identifying dietary factors promoting lean mass preservation in this population. Currently explored pharmacological support options include various human monoclonal antibodies (bimagrumab, trevogrumab, garetosumab). Introducing these drugs alongside semaglutide has promoted lean mass preservation despite fat mass loss. Currently existing studies should serve as a guide for further extensive research. At this time, it seems there are more questions than answers surrounding the issue of semaglutide’s impact on lean mass and strategies to mitigate its excess loss
FEATURES OF IMPORTANCE FOR THE DEVELOPMENT OF PROJECT DOCUMENTATION IN THE SECTION OF PARK AND PUBLIC LAND DEVELOPMENT IN BULGARIA
Get PDFThe organization of the territory is a system of measures, acts and actions of a factual and legal nature, which aim to create normal conditions for the use of the earth's surface for work, recreation and recovery of the population